Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 1;78(8):886-895.
doi: 10.1001/jamapsychiatry.2021.0967.

Racial/Ethnic, Social, and Geographic Trends in Overdose-Associated Cardiac Arrests Observed by US Emergency Medical Services During the COVID-19 Pandemic

Joseph Friedman  1   2 , N Clay Mann  3 , Helena Hansen  1 , Philippe Bourgois  1 , Joel Braslow  1 , Alex A T Bui  2   4 , Leo Beletsky  5   6   7 , David L Schriger  8
Affiliations

Racial/Ethnic, Social, and Geographic Trends in Overdose-Associated Cardiac Arrests Observed by US Emergency Medical Services During the COVID-19 Pandemic

Joseph Friedman et al. JAMA Psychiatry. .

Abstract

Importance: Provisional records from the US Centers for Disease Control and Prevention (CDC) through July 2020 indicate that overdose deaths spiked during the early months of the COVID-19 pandemic, yet more recent trends are not available, and the data are not disaggregated by month of occurrence, race/ethnicity, or other social categories. In contrast, data from emergency medical services (EMS) provide a source of information nearly in real time that may be useful for rapid and more granular surveillance of overdose mortality.

Objective: To describe racial/ethnic, social, and geographic trends in EMS-observed overdose-associated cardiac arrests during the COVID-19 pandemic through December 2020 and assess the concordance with CDC-reported provisional total overdose mortality through May 2020.

Design, setting, and participants: This cohort study included more than 11 000 EMS agencies in 49 US states that participate in the National EMS Information System and 83.7 million EMS activations in which patient contact was made.

Exposures: Year and month of occurrence of overdose-associated cardiac arrest; patient race/ethnicity; census region and division; county-level urbanicity; and zip code-level racial/ethnic composition, poverty, and educational attainment.

Main outcomes and measures: Overdose-associated cardiac arrests per 100 000 EMS activations with patient contact in 2020 were compared with a baseline of values from 2018 and 2019. Aggregate numbers of overdose-associated cardiac arrests and percentage increases were compared with provisional total mortality in CDC records from rolling 12-month windows with end months spanning January 2018 through July 2020.

Results: Among 33.4 million EMS activations in 2020, 16.8 million (50.2%) involved female patients and 16.3 million (48.8%) involved non-Hispanic White individuals. Overdose-associated cardiac arrests were elevated by 42.1% nationally in 2020 (42.3 per 100 000 EMS activations at baseline vs 60.1 per 100 000 EMS activations in 2020). The highest percentage increases were seen among Latinx individuals (49.7%; 38.8 per 100 000 activations at baseline vs 58.1 per 100 000 activations in 2020) and Black or African American individuals (50.3%; 21.5 per 100 000 activations at baseline vs 32.3 per 100 000 activations in 2020), people living in more impoverished neighborhoods (46.4%; 42.0 per 100 000 activations at baseline vs 61.5 per 100 000 activations in 2020), and the Pacific states (63.8%; 33.1 per 100 000 activations at baseline vs 54.2 per 100 000 activations in 2020), despite lower rates at baseline for these groups. The EMS records were available 6 to 12 months ahead of CDC mortality figures and showed a high concordance (r = 0.98) for months in which both data sets were available. If the historical association between EMS-observed and total overdose mortality holds true, an expected total of approximately 90 632 (95% CI, 85 737-95 525) overdose deaths may eventually be reported by the CDC for 2020.

Conclusions and relevance: In this cohort study, records from EMS agencies provided an effective manner to rapidly surveil shifts in US overdose mortality. Unprecedented overdose deaths during the pandemic necessitate investments in overdose prevention as an essential aspect of the COVID-19 response and postpandemic recovery. This is particularly urgent for more socioeconomically disadvantaged and racial/ethnic minority communities subjected to the compounded burden of disproportionate COVID-19 mortality and rising overdose deaths.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Overdose-Associated Cardiac Arrest (OCA) Counts in Aggregate and per 100 000 Emergency Medical Services (EMS) Activations, 2018-2020
Dotted lines represent results based on the sensitivity analysis.
Figure 2.
Figure 2.. Overdose-Associated Cardiac Arrests (OCAs) Percentage Changes and Aggregate Numbers, Stratified by Race/Ethnicity, Census Region, and Neighborhood Characteristics
All categories are sorted from greatest to least change. The vertical line on each graph indicates the mean percentage change.
Figure 3.
Figure 3.. Overdose-Associated Cardiac Arrests (OCAs) per 100 000 Activations and Percentage Increases by Census Division, 2020
Percentage changes are relative to baseline (a mean of values from 2018 and 2019).
Figure 4.
Figure 4.. Validation Exercise: Concordance Between Emergency Medical Services (EMS)–Observed Overdose-Associated Cardiac Arrests and Total Provisional Overdose Deaths
A, Dashed line of equality is plotted to show where the percentage change in both metrics is equal. B, Bland-Altman diagram for percentage change in both measures. The solid line marks 0, and the central dashed line shows the mean difference between the percentage errors in both data sets, which should be close to 0 for concordant measures. The outer dashed lines mark 2 SDs from the mean. Ideally, 95% of points should fall within these bounds for concordant measures. A and C, A line of best fit and 95% CIs are also shown for both percentage increase and aggregate numbers. CDC indicates the US Centers for Disease Control and Prevention.
See this image and copyright information in PMC

References

    1. US Centers for Disease Control and Prevention . Products: vital statistics rapid release, provisional drug overdose data. Published December 8, 2020. Accessed December 25, 2020. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
    1. Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018;361(6408):eaau1184. doi: 10.1126/science.aau1184 - DOI - PMC - PubMed
    1. Wakeman SE, Green TC, Rich J. An overdose surge will compound the COVID-19 pandemic if urgent action is not taken. Nat Med. 2020;26(6):819-820. doi: 10.1038/s41591-020-0898-0 - DOI - PMC - PubMed
    1. US Centers for Disease Control and Prevention . Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. Published December 17, 2020. Accessed December 25, 2020. https://emergency.cdc.gov/han/2020/han00438.asp
    1. Spencer MR, Ahmad F. Timeliness of death certificate data for mortality surveillance and provisional estimates: CDC vital stat rapid release. Published December 2016. Accessed April 21, 2021. https://www.cdc.gov/nchs/data/vsrr/report001.pdf

Publication types

MeSH terms